Did underdosing affect longevity?

As a scientist in cancer drug discovery, I was eager to read Diana Zlomislic and Tim Alamenciak’s behind-the-scenes exposé on Ontario’s chemotherapy scandal. However, reading the article confirmed my suspicions that this issue is being dramatically overblown.

While I am not an oncologist, I do know, as was alluded to in the article by Windsor Regional Hospital Oncology chief Ken Schneider, that patient’s responses to chemotherapy can vary dramatically, with respect to both antitumor response and toxic side effects.

Against this background, effects of the underdosing at the centre of this scandal would be expected to be quite minor. To directly quote the Star, two oncologists interviewed believed that “the physical effect is minimal. Of more immediate concern is the psychological impact.”

The Star adds to the hysteria by printing statements like, “Since starting their treatments, 137 of these patients have died.” This is irresponsible; the tragic heart of the matter is that cancer patients often die, even ones who receive the best available treatment.

A more appropriate evaluation would be to determine if the underdosing significantly shortened patients’ lifetimes, or the periods before their disease returned. Such statistical analyses could take up to five years or longer to complete, but I sincerely hope they are being undertaken. It would have been nice of the Star to find out.

I am not trying to defend Marchese Hospital Solutions or public regulators, nor is it my intent to trivialize the terrible ordeal that cancer patients go through. Rather, this letter is a criticism of the Star for worsening cancer patients’ “psychological impact” by adding to the hysteria.

Instead, the Star could have performed a public service by concluding that the underdosing probably had no effect on patients’ outcomes anyway. Such a conclusion would have been completely consistent with the facts presented in the article.

Finally, I would like to point out that the patients were not underdosed by 20 per cent, as has been repeatedly reported by the Star and others. Instead, an overfill of 20 per cent results in an underdosing of 20/120, or 16.7 per cent. This may sound like nitpicking, but if the Star does not take steps to correct this error, then they are guilty of the same basic mathematical deficiencies as Marchese Hospital Solutions.

Richard Brokx, PhD, Toronto

It is a credit to Star staff reporters that the breakdown of monumental proportions in the chemotherapy supply chain is being regularly examined in detail to help us understand and help avoid such occurrences in the future.

Had it not been for a sharp-eyed technician noticing that the labelling was wrong, and the press bringing this to the fore, countless cancer patients may not have benefited from the investigation headed by Dr. Jake Thiessen, founding director of the University of Waterloo school of pharmacy.

Let us hope that the lessons are not lost. This provides a timely opportunity for provincial Health Minister Deb Matthews and federal Health Minister Leona Aglukkaq, who were quick in responding to this issue, to now ensure that adequate measures are firmly in place in order to avoid such disasters in the future.